General Ward Nurses Detection and Response to Clinical Deterioration in Three Hospitals at the Kenyan Coast: A Convergent Parallel Mixed Methods Study

Abstract

Abstract Background In low and middle-income countries like Kenya, critical care facilities are limited, which means acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to clinical deterioration. Methods This convergent parallel mixed-methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the patients' vital signs 24 hours before a cardiac arrest (death) occurred was retrieved from patients' medical records. Additionally, in-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. Results This study reviewed 405 patient records and found that most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 hours prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs, availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. Conclusion The study showed that nurses did not consistently monitor and record vital signs in the general wards. The nurses worked in suboptimal ward environments characterised by inadequate and malfunctioning monitoring equipment, high workload due to staff shortages, communication and teamwork gaps, and little training on handling patient deterioration at the ward level; factors that negatively impact patient safety and outcomes. The findings provide an opportunity for future research to test interventions to improve nurses' assessment and management of clinical deterioration in general wards.